Kim Jon Dipasquale, DDS MS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D29722 Issued in CA

Practice address

500 So Anaheim Hills Road
Suite 222
Anaheim Hills, CA 92807

Phone

(714) 974-5906

Fax

(714) 974-5982

NPI assigned

Jan 29, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beau McKenzie Soares D.D.S., Inc

  • Oral and Maxillofacial Surgery Clinic/Center
  • Anaheim, CA
  • NPI 1265710826
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104962224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SO ANAHEIM HILLS ROAD",
            "address_2": "SUITE 222",
            "city": "ANAHEIM HILLS",
            "state": "CA",
            "postal_code": "92807",
            "telephone_number": "714-974-5906",
            "fax_number": "714-974-5982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SO ANAHEIM HILLS ROAD",
            "address_2": "SUITE 222",
            "city": "ANAHEIM HILLS",
            "state": "CA",
            "postal_code": "92807",
            "telephone_number": "714-974-5906",
            "fax_number": "714-974-5982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIPASQUALE",
        "first_name": "KIM",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "DDS MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "D29722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terisa Marie Brown-Sienko, NP
• Harry Joel Charm, OD
• Caren Hui-Min Chen, MD
• Children'S Medical Group of Orange County Apc
• Bernadine M Deramo, NP
• Dr Mahadev MD Inc
• F.Foroutan DDS Inc.
• Janet Eileen Frazier, L.M.F.T, DR. P.H.
• Donna Jo Frisch, MD
• Xuhong Gao, ACUPUNCTURIST

• Oral and Maxillofacial Surgery (Dentist) in Anaheim Hills, CA
• Providers in Anaheim Hills, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.